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General NPI Number Information
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NPI Number | 1437681467
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE HOLISTIC HEALTH CENTER LLC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 105 N MAIN ST
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2020
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Country | US
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Telephone | 937-407-6293
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Fax |
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Provider Business Mailing Address
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Address Line | 105 N MAIN ST
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2020
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Country | US
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Telephone | 937-407-6293
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACI POWELL
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Credential |
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Telephone | 937-407-6293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 17291
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License Number State | OH
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